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Significant changes from previous version Removal of 800 series SOP, change of Name from Bayer to
Siemens, Ward 9A analyser re-located to Ward 6B, Analyser list transferred to separate information document.
Reported interference to glucose & lactate from Pralidoxime Iodide. Clinical interpretations deleted, contact
laboratory for these.
INDEX OF CONTENTS
Page
3) System Overview
4) Standard Operating Procedure for laboratory based personnel (Rapidlab 1200 series analysers)
8) Standard Operating Procedure for laboratory based personnel (Rapidpoint 405 analysers)
10) Sample analysis for laboratory based Rapidlab 1200 series analysers
12) Standard Operating Procedure for ward based personnel (Rapidpoint 405 and Rapidlab 1200 series
analysers)
15) Appendices
27) Risk Assessments
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Instrumentation
Information concerning individual chemistries: - principles of analysis, clinical interpretation etc. are to
be found in the appendices at the end of this document.
Parameters available on each instrument vary according to location.
The instruments and locations are listed in the document Siemens critical care analyser list
Quality Control
For Rapidpoint 405 & Rapidlab 1200 series analysers, three levels of AQC are carried out
automatically, one level every 4 hours according to a pre programmed timetable. Any sensor failing IQC
at one or more levels is disabled by the analyser until the errors are resolved. The AQC cartridges are
stored at 2-80C in fridge room 4063 and are stable until expiry date. (Siemens part number 05293926)
Cumulative performance for all Analysers is archived by and may be viewed from the RAPIDCOM
computer (see separate SOP)
All analysers are registered for monthly EQA under WEQAS
Maintenance procedures
1. EACH LOCATION REQUIRES A DAILY VISIT AND according to each instruments
schedule weekly maintenance must be carried out. (For low use instruments, 6B, BGH Lab &
BGH ward 11 this should be carried out ever two weeks) N.B. It is essential that one of the
ITU analysers is always available. Therefore maintenance must always be completed on one
analyser before commencing work on the second.
2. 405 & 1200 series analysers require their cartridges to be changes at defined intervals.
3. The analysers based at LWH HDU and BGH WD 11 are maintained by trained ward staff.
For BGH WD 11 this is the ward manager
For LWH HDU contact the ward manager
4 When laboratory staff visit clinical areas to carry out maintenance or to train staff a clean
laboratory coat must be worn. When entering wards or clinical areas hands must be cleaned
with the alcohol based hand rub provided. A bottle of this must be carried in event of their
being no supply at the entrance to the ward.
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1)
Analyser Overview
2)
Maintenance Procedures
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Analyser overview
The 1200 series analysers use the same electrode system as the earlier 800 series analysers and the
maintenance of these is similar, although the PCO2, PO2, Ca, and reference sensors are specific for the
1200 series and labelled as such. The reagent cartridge, control systems, sample analysis and AQC are
similar to the 400 series. They are as follows: Automatic QC cartridge 05293926, store at 2-80C in cold room 4063 (this is the same as the 400 series)
Reagent cartridge 03909458 store at 2-80C in cold room 4063
Wash Cartridge 03913056 store at room temp. in room 4010
2)
Maintenance procedures
Daily
1. Check Rapidcomm for cartridge status sensor stability and IQC performance
2. Check analyser status screen.
3 Change analyser cartridges if required instruction video will be activated when the icon
representing the expired cartridge is touched. NB once a cartridge has been removed from the
analyser, it cannot be refitted for continuing use. Replacement Reagent and QC cartridges are
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stored in the Endocrine cold room. Wash cartridges and waste containers are kept with other
blood gas consumables in the reagent store-room, at least one of each must be kept in the BGH
lab to be readily available if required by one of the wards.
Note the analyser will display a visual warning when any cartridge is within 24 hrs. of expiry
or when there are less than 10% remains.
Clean analyser surface, small blood spots can be removed with 0.5% hypochlorite.
Report any misuse of analyser to ward manager and to senior BMS (e.g. blood spills used
syringes or needles left on analyser)
Check and replace printer paper roll, instruction video available through user manual icon
(stock of paper with other blood gas analyser supplies in reagent store room)
Service or replace any failed sensors
Note that if any of the sensors have been replaced or disturbed then the analyser must be fully
calibrated and all levels of IQC measured before anyone is permitted access to analyse samples.
Used cartridges must be treated as contaminated waste and disposed at the site of use in
yellow clinical waste bags
2)
3)
Remove the old sensor and install new, ensure that the sensor is making good contact at all four
points.
4)
Close compartment
5)
Calibrate the sensor.
N.B. the sensor may require up to 30 minutes before stabilizing and satisfactory calibration. If successful
calibration is not achieved after at least one hour and/or several calibration attempts, remove another
electrode from the fridge and install this after the 30 minute warm up period as described above.
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ii)
iii)
iv)
v)
2)
These sensors and associated fill solutions are stored at room temperature.
The box containing the sensor also contains a filling needle & a vial of filling solution.
This solution is interchangeable between Na, K, Cl, Ca sensors. The pH fill solution is unique to
the pH sensor.
Remove the centre electrode by unscrewing from the body of the sensor and set to one side
taking care not to touch the central pin. Fit the filling needle to the vial of electrode fill solution
& fill the body of the sensor from the bottom to no more than 80% full for K, Cl & Ca sensors
and 90% full for Na & pH sensors. Refit the central electrode & gently tap the sensor to ensure
that there are no bubbles on the membrane.
Open the electrode compartment. Release the clamp on the right.
Remove the old sensor and install new
The response of the sensor can often be restored by replacing the sensor fill solution.
To do this, unscrew the centre electrode & set to one side taking care not to touch the central
pin. Gently tap the old electrolyte out onto a tissue and replace with fresh as in step 2, refit the
central electrode and tap gently to dislodge any bubbles that may be trapped on the membrane.
Refit sensor to the instrument and recalibrate
N.B. if there are glucose or lactate sensors fitted you will be prompted to remove the glucose and lactate sensors
and install TB4 dummy electrodes and press OK to confirm BEFORE PROCEEDING WITH DEPROTEINISER.
FAILURE TO DO THIS WILL CAUSE IRREPARABLE DAMAGE TO THE SENSORS WHICH WILL
REQUIRE REPLACEMENT.
iii)
Insert syringe of deproteiniser to sample port and press ANALYSE
Remove syringe when prompted. This takes 5 minutes.
iv)
Instrument will then prompt to ask for CONDITION??
Transfer the contents of one conditioner vial to a 5ml syringe and present to the analyser sample
port and press ANALYSE.
Remove syringe when prompted.
This takes 5 minutes.
You will be prompted to remove the dummy electrodes and re-install glucose and lactate sensors and press
OK to confirm BEFORE PROCEEDING WITH CALIBRATION.
v)
Instrument will then prompt CALIBRATE?? press YES to calibrate.
The instrument may require 2 or 3 calibrations after a clean/condition before all electrodes
re-stabilise.
Note that if any of the sensors have been replaced or disturbed then the analyser must be fully
calibrated and all levels of IQC measured before anyone is permitted access to analyse samples.
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Clean analyser surface, small blood spots can be removed with 0.5% hypochlorite.
Report any misuse of analyser to ward manager and to senior BMS (e.g. blood spills used
syringes or needles left on analyser)
Check and replace printer paper roll, instruction video available through user manual icon
(stock of paper with other blood gas analyser supplies in reagent store room)
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Used cartridges must be treated as contaminated waste and disposed at the site of use in
yellow clinical waste bags
Conditioning of the measure cartridge with blood or plasma is necessary for optimal performance.
If the instrument is frequently used, normal analysis of patient samples will be sufficient for this.
If the analyser is only used infrequently then a conditioning sample must be analysed as soon as the
analyser has completed its initial calibration following installation.
This sample is provided by the laboratory to the appropriate units, the most suitable material being
an expired serum IQC.
The sample is transferred to a 1ml syringe and analysed 5 times. The patient data entered should
be: - Patient ID - 7654321Q. Last Name BLOGGS. The results obtained have no meaning and
should be discarded.
There are two analysers that this should be performed on : - BGH Theatre and LWH HDU
Failure to carry out this procedure may result in the failure of the Measure Cartridge, which Siemens
will then refuse to replace.
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Analysis procedure The sample should be booked into Telepath prior to analysis if duplicate
sample records are to be avoided.
1. Mix the sample by rotating between the palms of the hands for 30 seconds immediately prior to
analysis.
2. Check - that the analyser is in the ready mode (visible top LH corner of screen). If it is calibrating or
purging, wait until complete *DO NOT CANCEL*. Enter your password/PIN Locate the sample
on the Luer fitting and press the GREEN arrow in the bottom RHS of screen. Wait until prompted
by the analyser before removing sample. The data entry screen will be displayed and must be
completed according to the following protocol:PATIENT ID
Full unit number As entered into Telepath, this is best entered using the bar-code reader. If an RQ6
number the analyser will retrieve the patient s information from the server (this may be entered before
analysis, option 1 on analyser using the bar-code reader)
ACCESSION NUMBER
Laboratory number - As on the Bar-code label, the CARD ONLY bar code may be used to input this.
LOCATION
Requesting unit or ward
TEMPERATURE
If the patients temperature is entered the analyser will produce temperature corrected pH, pCO2, & PO2.
In no temperature is entered the default is 36.4
FiO2
Enter the patients inspired oxygen. As percent (if known) N.B.
On air = 21
OPERATOR
THIS WILL CONTAIN YOUR NAME or UNIQUE ID NUMBER, AND IS DEPENDENT ON YOUR
PASSWORD. IT CANNOT BE ALTERED.!!
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Please note data fields marked with are mandatory, and must be completed.
3. When all patient data is entered, press the GREEN arrow. The results will print out to include: patient data & the user ID number of the analyst.
4. The analyser is interfaced with Telepath via Siemens Rapidcom. If the sample has been registered with
telepath the results will download directly. Ensure that results have transferred to T Path
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SIEMENS RAPIDPOINT 405 AND 1200 SERIES BLOOD GAS & ELECTROLYTE
ANALYSERS.
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The full SOP for the use of Siemens Blood Gas Analysers, of which the following page is an extract, is
located by the Analyser & is also part of the Lab Handbook which may be viewed electronically.
It may also be viewed at: - www.rlbuht.nhs.uk/jps/gas_sop.pdf (from any P.C.)
To perform a Blood Gas Analysis the operator must have been present when the sample was drawn.
Performing blood gas analysis (Siemens Rapidpoint 405 & 1200 series analysers)
Check that the analyser is READY (visible in top LH corner of screen).
A yellow triangle with legend ANALYSER REQUIRES OPERATOR ATTENTION is for laboratory
information and may not indicate an immediate problem with the analyser
The analyser is operated using a touch sensitive VDU and the connected Bar-Code- Reader, it is also
possible to access a full training manual including video clips for the most commonly performed operations.
Using this screen, enter your PIN & press the green arrow in the bottom right corner, if your password is on
a bar-code, scan it with the reader. Locate the sample in the Luer fitting & press the green arrow.
Remove the sample when prompted and press the green arrow.
If the 1200 analyser detects a short sample it will offer the option of micro sample Follow the on
screen instructions if this is required. The data entry screen will now be available and the data fields must
be completed according to the following protocol: PATIENT ID
FULL UNIT NUMBER as shown in examples below
RQ61234567, 5NL0001234, W0123456 or NHS number is acceptable. If the unit number has an
associated bar-code it should be scanned with the reader. For RQ6------- numbers, the analyser will
interrogate the Hospital database, if the record is found the following LAST NAME data-field will be
completed (note that data retrieved cannot be altered on the analyser). If it is not found then the LAST
NAME data-field must be completed as follows: LAST NAME
PATIENT S FAMILY NAME
When patient s ID is not known the above fields should be filled with as much information as possible,
otherwise enter UNKNOWN + time of admission in the PATIENT ID field,
and patient sex + time of admission in LAST NAME field
LOCATION
REQUESTING UNIT OR WARD
TEMPERATURE
If the patient s temperature is entered the analyser will produce corrected results, if no entry 36.4 is the default.
FiO2
ENTER THE PATIENTS INSPIRED OXYGEN (On air = 21)
This will then be printed on the report to aid interpretation of results.
USER ID
THIS WILL CONTAIN YOUR UNIQUE ID NUMBER, IT IS DEPENDENT ON YOUR PASSWORD.
Please note data fields marked with are mandatory, and must be completed. When all patient data is entered,
press the GREEN ARROW. The results will print out to include patient data & the ID Number of analyst.
YOU MUST NOT REVEAL YOUR PASSWORD TO ANYONE ELSE.
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APPENDICES
Appendix A
Appendix B Co-oximetry
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APPENDIX A
Blood Gas
Acid Base
pH
Extra-cellular pH correlates closely with intracellular pH. pH is therefore valuable as a general indicator of
intracellular acid-base status. pH is clinically significant as a means of determining acid-base disorders that
can be caused by several pathological conditions such as ventilatory dysfunction and renal or gastrointestinal
inadequacy.
Principle of analysis
The pH sensor is a half-cell that forms a complete electrochemical cell when combined with the
external reference sensor. The pH sensor contains a Silver/Silver Chloride wire surrounded by a
buffer solution.
A glass membrane that is highly sensitive and specific for H+ ions separates the sample from the
buffer solution.
When sample comes into contact with the glass membrane the passage of H+ ions generates a
potential, which is measured by a voltmeter. This reflects the H+ concentration (& therefore pH)
when compared to the constant potential generated by the reference electrode
pH = log10[H+]
Reference Range
pH
7.34 - 7.44
H+ ion 36 42 nmol/l
Reporting range
pH
Principle of analysis
The pCO2 sensor is a complete electrochemical cell that consists of a measuring electrode and an
internal reference electrode. The measuring electrode, which is a pH electrode is surrounded by a
Chloride/Bicarbonate solution. A membrane, permeable to gaseous CO2 separates this solution from
the sample. The internal reference electrode, which contains a Silver/Silver Chloride electrode
surrounded by the Chloride-Bicarbonate solution, provides a fixed potential.
Reference Range
(Arterial)
Reporting range
pCO2
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pO2
Oxygen (O2) is essential for cell and tissue metabolism. Oxygen transport comprises four major steps: Convection and diffusion from the air into the pulmonary circulation.
Combination of O2 with haemoglobin within the red cells to form oxy-haemoglobin.
Transportation via the arteries to the cells.
Release into the tissues and utilisation of O2 at the cellular level.
The measurement of arterial pO2 is used to indicate the arterial tension within arterial blood and
therefore the degree of hypoxaemia present in a patient sample.
Principle of analysis
The pO2 sensor is a complete electrochemical cell that incorporates amperometric technology. The
sensor consists of a platinum cathode and a silver anode, an electrolyte solution and a gas permeable
membrane.
A constant (polarizing) voltage is maintained between the anode and the cathode. As dissolved
oxygen passes through the membrane into the electrolyte solution it is reduced at the cathode.
O2 + 2H2O + 4e-
4OH-
4Ag+ + 4e-
The amount of reduced oxygen is directly proportional to the number of electrons gained at the
cathode.
Reference Range
(Arterial)
Reporting range
pO2
The Hb may be an assayed value from the associated co-oximeter, derived from a measured haematocrit or it
can be an assumed value entered into the analyser set-up.
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Base excess
The calculation of the base excess of blood permits the estimation of the number of equivalents of sodium
bicarbonate or ammonium chloride required to correct the blood pH to 7.40
The base excess, in blood, with a pH of 7.40, - pCO2 of 5.33 kPa - Hb of 15.0 g/dl at 37oC is zero.
It is calculated as follows
BE(B) = (1 - 0.014 * Hb) [(HCO3- - 24.8) + (1.43 * Hb + 7.7)(pH - 7.40)]
The Hb may be an assayed value from the associated co-oximeter, derived from a measured haematocrit or it
can be an assumed value entered into the analyser set-up.
HCO3- (actual) is derived as follows: - log HCO3- = pH + log(pCO2 * 0.0307) - 6.105
(National Committee for Clinical Laboratory Standards Recommendations)
Reference Range
-2.3 - +2.3mmol/l
Turnaround time
Samples analysed immediately upon receipt.
Assay characteristics
Precision: -
pH
pC02
p02
=
=
=
0.08%
2.3
4.1
pH
7.1 - 7.6
pC02 2.0 - 19.0
p02
4.0 - 93.0
Reference Range
pH
pC02
p02
Std Bicarbonate
Base Excess.
7.34 - 7.44
4.7 - 6.0
11.3 - 14.0
22 - 26
-2.3 - +2.3
Further Information
Maintenance and reagent logs must be completed daily.
Specimens arriving with needle still attached must not be analysed. The medic who took the sample should be
requested to either come to the laboratory and remove the needle or send an alternative specimen.
Calibration is automatic and occurs at pre programmed intervals.
References
1.
Hamilton, L.H. Respiratory and blood gas analysis. Prog Clin Pathol 1969; 9: 284-340.
2.
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APPENDIX B
CO-oximetry
This module, if present, measures Haemoglobin and other related compounds in whole blood at the same time as
blood gas analysis.
Principle of analysis
The CO-oximeter measures haemoglobin and related compounds by passing polychromatic light through a lysed
sample of blood. The reflected light is measured at several wavelengths so differentiating between the
compounds according to their absorbance spectra.
Interferences
CO-oximetry is affected by the presence of turbidity, bilirubin, cyanmethaemoglobin and dyes in the sample.
Haemoglobin
Haemoglobin is a tetrameric protein consisting of two pairs of polypeptide chains, each chain having a haem
group containing one atom of Iron. Each molecule of Haemoglobin can bind up to four molecules of oxygen,
one at each haem group. Haemoglobin has a key role in the transport of oxygen from the lungs to the tissues.
Haemoglobins ability to bind & release oxygen depends on several factors: - pH, PCO2, PO2,
diphosphoglycerate concentration & temperature.
The presence of dyshaemoglobins such as carboxyhaemoglobin, methaemoglobin, sulfhaemoglobin may also
affect normal oxygen transport mechanism. Abnormal concentrations of haemoglobin variants such as foetal
haemoglobin may also affect this.
The measure of total haemoglobin includes all these fractions of haemoglobin plus the oxygenated and reduced
forms.
Reference Range 12.0 18.0 g/dL
Deoxyhaemoglobin (HHb)
Refers to the haemoglobin capable of binding oxygen (sometimes referred to as reduced haemoglobin)
Reference Range 0.0 5.0% (Arterial)
Methaemoglobin (MetHb)
Methaemoglobin is haemoglobin whose iron has been oxidized to Fe3+ and is unable to bind oxygen.
Reference range
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APPENDIX C
ELECTROLYTE ASSAYS
Sodium
Principle of analysis
The sodium sensor is a half-cell that forms a complete electrochemical cell when combined with the external
reference sensor. The Na sensor contains a Silver/Silver Chloride wire surrounded by an electrolyte solution
with a fixed concentration of Na & Cl ions
A glass membrane that is highly selective for sodium ions over other clinically encountered cations,
separates the sample from the electrolyte solution.
When sample comes into contact with the glass membrane the exchange of Na+ ions generates a potential,
which is measured by a voltmeter. This reflects the Na+ concentration when compared to the constant
potential generated by the reference electrode.
As the sample is not pre-diluted as with the routine laboratory analysers, this assay (direct ISE) is not subject
to pseudo dilution effect and therefore is the method of choice when paraproteinaemia or
hypertriglyceridaemia is suspected.
Reference range
135 145 mmol/l (Plasma)
Whole blood slightly lower (Reference range
Reporting range: 100
70
not established)
Interfering substances
The following substances were found to interfere with the Sodium assay: -
Substance
Dobutamine
Benzalkonium Heparin
Heparine Leo
Concentration tested
5mg/dl
800 850 U/ml
Level of interference
+6.0 mmol/l
> 50 mM
-12.6 mM
It is recommended that the sample be treated as mixed venous when Benzalkonium Heparin is used. Some
pulmonary artery catheters may also contain the Benzalkonium ion, which interferes with analysis.
Potassium
Principle of analysis
The potassium sensor is a half-cell that forms a complete electrochemical cell when combined with the
external reference sensor. The K sensor contains a Silver/Silver Chloride wire surrounded by an electrolyte
solution with a fixed concentration of potassium ions
Ionophore valinomycin immobilised in a plasticised PVC matrix forms the membrane that separates the
sample from the electrolyte solution. Valinomycin is a neutral ion carrier that is highly selective for
potassium ions over other clinically encountered cations.
When sample comes into contact with the valinomycin membrane the exchange of K+ ions generates a
potential, which is measured by a voltmeter. This reflects the K+ concentration when compared to the
constant potential generated by the reference electrode
Reference range
3.5 5.0 mmol/l (Plasma)
Whole blood slightly lower (Reference range
Reporting range: 0.50
0.50
not established)
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Interferences
Benzalkonium Heparin has been shown to interfere with potassium sensor, increasing apparent levels by
>0.15 mmol. It is recommended that the sample be treated as mixed venous when Benzalkonium Heparin is
used. Some pulmonary artery catheters may also contain the Benzalkonium ion, which interferes with
analysis.
Caution should be exercised when interpreting whole-blood potassium assays as haemolysis, which
may falsely elevate the potassium level, will not be apparent.
Chloride
Principle of analysis
The chloride sensor is a half-cell that forms a complete electrochemical cell when combined with the
external reference sensor. The chloride sensor contains a Silver/Silver Chloride wire surrounded by an
electrolyte solution with a fixed concentration of chloride ions
A derivitized quarternary ammonium compound immobilised in a polymer matrix, forms the membrane that
separates the sample from the electrolyte solution. The membrane acts as an ion exchanger that is highly
selective for chloride ions over other ions in the sample.
When sample comes into contact with the membrane the exchange of Cl- ions generates a potential, which is
measured by a voltmeter. This reflects the Cl- concentration when compared to the constant potential
generated by the reference electrode
Interfering substances
Substance
Salicylic acid
Salicylic acid
not established)
The following substances were found to interfere with the Chloride assay: -
Concentration tested
50mg/dl
20mg/dl
Level of interference
+9.5 mmol/l
+1.8 mmol/l
Ionised Calcium
Principle of analysis
The calcium sensor is a half-cell that forms a complete electrochemical cell when combined with the external
reference sensor. The Ca sensor contains a Silver/Silver Chloride wire surrounded by an electrolyte
solution with a fixed concentration of calcium ions
An Ionophore immobilised in a PVC matrix forms the membrane that separates the sample from the
electrolyte solution. The ionophore is a compound that is highly selective for calcium ions over other ions.
When sample comes into contact with the membrane the exchange of Ca++ ions generates a potential, which
is measured by a voltmeter. This reflects the Ca++ concentration when compared to the constant potential
generated by the reference electrode
Reference range
not established)
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Interfering substances
Substance
Salicylic acid
Salicylic acid
The following substances were found to interfere with the Calcium assay: -
Concentration tested
50mg/dl
30mg/dl
Level of interference
-6%
-3%
APPENDIX D
METABOLITES
Principle of analysis
The glucose & lactate sensors are complete electrochemical cells that incorporate amperometric technology to
measure glucose or lactate concentration in samples. The sensors consist of 4 electrodes
The measuring electrode contains platinum and either glucose oxidase or lactate oxidase in a binder, while the
reference electrode is silver/silver chloride. Of the remaining two electrodes one is a platinum conductor that
ensures a constant applied potential, the 4th electrode is another measuring electrode without the enzyme. This
determines interfering substances in the sample, subtracting them from the total measurement. A microporous
cover membrane separates the electrodes from the sample.
A constant polarizing voltage is maintained during analysis.
The relevant reactions are shown below: -
Glucose
Glucose oxidase acts on glucose in the sample to form hydrogen peroxide and gluconic acid.
GOX
C6H12O6 + H2O
C6H12O7 + H2O2
Where GOX is the glucose oxidase
The polarizing voltage causes oxidation of the hydrogen peroxide
H2O2
2H+ + O2 + 2e-
The loss of the electrons creates a current flow that is directly proportional to the level of glucose in the sample.
Lactate
Lactate oxidase acts on lactate in the sample to form hydrogen peroxide and pyruvic acid.
LOD
C3H6O3 + H2O + O2
C3H4O3 + H2O2
Where LOD is the Lactate oxidase
The polarizing voltage causes oxidation of the hydrogen peroxide
+
H2O2 2H + O2 + 2eThe loss of the electrons creates a current flow that is directly proportional to the level of lactate in the sample.
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Interfering substances
Substance
Sodium Fluoride
Acetoaminophen
Sodium Fluoride/
potassium oxalate
Pralidoxime
Iodide
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The following substances were found to interfere with the glucose assay: -
Concentration tested
1000mg/dl
2mg/dl
1000mg/dl
(each)
16ug/l
Level of interference
+1.4 mmol/l
+0.4 mmol/l
+1.4mmol/l
Lactate
Interfering substances
Substance
Sodium Fluoride
Acetoaminophen
Sodium Fluoride/
potassium oxalate
Pralidoxime
Iodide
The following substances were found to interfere with the lactate assay: -
Concentration tested
1000mg/dl
2mg/dl
1000mg/dl
(each)
64/ug/l
Level of interference
+1.0 mmol/l
+0.35 mmol/l
+1.0 mmol/l
There have also been reports of positive interference to the Lactate assay from Ethylene Glycol and its
following metabolites: - Glycolic Acid, Formic Acid, Oxalic Acid and Glyoxylic Acid.
At time of SOP revision these had not been quantified
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APPENDIX E
RISK ASSESMENTS